Factors Affecting Presentation and Treatment of Pediatric/Adolescent Cancer Patients Diagnosed With SARS-CoV-2.
Journal
Journal of pediatric hematology/oncology
ISSN: 1536-3678
Titre abrégé: J Pediatr Hematol Oncol
Pays: United States
ID NLM: 9505928
Informations de publication
Date de publication:
01 04 2023
01 04 2023
Historique:
received:
24
02
2022
accepted:
24
11
2022
pubmed:
10
2
2023
medline:
28
3
2023
entrez:
9
2
2023
Statut:
ppublish
Résumé
It is thought that the clinical course of actively treated pediatric/adolescent cancer patients diagnosed with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is more severe than experienced by the general pediatric population. We describe the clinical course, risk factors affecting presentation, and management of coronavirus disease 2019 (COVID-19) infection for these patients. Patients at a single institution receiving cancer therapy while diagnosed with SARS-CoV-2 between January 2020 and June 2021 were retrospectively reviewed. Data collected included age at SARS-CoV-2 diagnosis, sex, ethno-race, adjusted body mass index, and active therapies. Twenty-nine patients met inclusion criteria, with 16 (55.2%) experiencing symptoms. Twenty-three (79.3%) patients required no institutional support; 10 (34.4%) required hospitalization, of which 80.0% required oxygen, 30.0% required intensive care, and 10.0% required intubation. Three (10.3%) patients developed MIS-C. Obesity increased odds of hospitalization (odds ratio=25.5; P =0.002) and oxygenation (odds ratio=14.88; P =0.012). Hospitalization and MIS-C rates were significantly higher than, whereas mortality rates and symptom presentations were consistent with, rates in the general pediatric population. Obesity was the only risk factor predictive of clinical severity. Cancer treatment modifications and pre-emptive administration of COVID-19 treatment did not modify clinical course.
Sections du résumé
BACKGROUND
It is thought that the clinical course of actively treated pediatric/adolescent cancer patients diagnosed with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is more severe than experienced by the general pediatric population. We describe the clinical course, risk factors affecting presentation, and management of coronavirus disease 2019 (COVID-19) infection for these patients.
METHODS
Patients at a single institution receiving cancer therapy while diagnosed with SARS-CoV-2 between January 2020 and June 2021 were retrospectively reviewed. Data collected included age at SARS-CoV-2 diagnosis, sex, ethno-race, adjusted body mass index, and active therapies.
RESULTS
Twenty-nine patients met inclusion criteria, with 16 (55.2%) experiencing symptoms. Twenty-three (79.3%) patients required no institutional support; 10 (34.4%) required hospitalization, of which 80.0% required oxygen, 30.0% required intensive care, and 10.0% required intubation. Three (10.3%) patients developed MIS-C. Obesity increased odds of hospitalization (odds ratio=25.5; P =0.002) and oxygenation (odds ratio=14.88; P =0.012).
CONCLUSIONS
Hospitalization and MIS-C rates were significantly higher than, whereas mortality rates and symptom presentations were consistent with, rates in the general pediatric population. Obesity was the only risk factor predictive of clinical severity. Cancer treatment modifications and pre-emptive administration of COVID-19 treatment did not modify clinical course.
Identifiants
pubmed: 36757018
doi: 10.1097/MPH.0000000000002628
pii: 00043426-202304000-00015
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e304-e308Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no conflict of interest.
Références
Guan WJ, Liang WH, Zhao Y, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J. 2020;55:1–14.
de Rojas T, Pérez‐Martínez A, Cela E, et al. COVID‐19 infection in children and adolescents with cancer in Madrid. Pediatr Blood Cancer. 2020;67:1–3
Liang W, Guan W, Chen R, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol. 2020;21:335–337.
Madhusoodhan PP, Pierro J, Musante J, et al. Characterization of COVID‐19 disease in pediatric oncology patients: The New York‐New Jersey regional experience. Pediatr Blood Cancer. 2021;68:1–9.
Chen ZM, Fu JF, Shu Q, et al. Diagnosis and treatment recommendations for pediatric respiratory infection caused by the 2019 novel coronavirus. World J Pediatr. 2020;16:240–246.
Balduzzi A, Brivio E, Rovelli A, et al. Lessons after the early management of the COVID-19 outbreak in a pediatric transplant and hemato-oncology center embedded within a COVID-19 dedicated hospital in Lombardia, Italy. Estote parati. Bone Marrow Transplant. 2020;55:1900–1905.
Dorantes-Acosta E, Ávila-Montiel D, Klünder-Klünder M, et al. Survival and complications in pediatric patients with cancer and COVID-19: a meta-analysis. Front Oncol. 2021;10:1–7.
Center for Disease Control. About Child & Teen BMI | Healthy Weight, Nutrition, and Physical Activity | CDC. Accessed October 18, 2021. https://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html .
Fernandes DM, Oliveira CR, Guerguis S, et al. Severe acute respiratory syndrome Coronavirus 2 clinical syndromes and predictors of disease severity in hospitalized children and youth. J Pediatr. 2021;230:23–31.e10.
American Cancer Society. Types of Cancer that Develop in Children. Cancer Facts & Figures 2019. Published 2019. Accessed August 30, 2021. https://www.cancer.org/cancer/cancer-in-children/types-of-childhood-cancers.html .
Miao K, Illuzzi F, Hwang AC. High Prevalence of Asymptomatic COVID-19 in the Pediatric Population. J Urgent Care Med. Published online October 2020. https://www.jucm.com/high-prevalence-of-asymptomatic-covid-19-in-the-pediatric-population/ .
Kim L, Whitaker M, O’Halloran A, et al. Hospitalization rates and characteristics of children aged <18 years hospitalized with laboratory-confirmed COVID-19 — COVID-NET, 14 States, March 1–July 25, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:1081–1088.
Mukkada S, Bhakta N, Chantada GL, et al. Global characteristics and outcomes of SARS-CoV-2 infection in children and adolescents with cancer (GRCCC): a cohort study. Lancet Oncol. 2021;22:1416–1426.
Payne AB, Gilani Z, Godfred-Cato S, et al. Incidence of multisystem inflammatory syndrome in children among US persons infected with SARS-CoV-2. JAMA Netw Open. 2021;4:1–13.
Simon Junior H, Sakano TMS, Rodrigues RM, et al. Multisystem inflammatory syndrome associated with COVID-19 from the pediatric emergency physician’s point of view. J Pediatr (Rio J). 2021;97:140–159.
Pandrowala A, Panchal H, Mudaliar S, et al. SARS‐CoV‐2‐related multisystem inflammatory syndrome in an immunocompromised child with leukemia. Pediatr Blood Cancer. 2021;68:1–3.
Gruber CN, Patel RS, Trachtman R, et al. Mapping systemic inflammation and antibody responses in multisystem inflammatory syndrome in children (MIS-C. Cell. 2020;183:982–995.e14.
Nakra N, Blumberg D, Herrera-Guerra A, et al. Multi-system inflammatory syndrome in children (MIS-C) following SARS-CoV-2 infection: review of clinical presentation, hypothetical pathogenesis, and proposed management. Children. 2020;7:1–14.
Gampel B, Troullioud Lucas AG, Broglie L, et al. COVID‐19 disease in New York City pediatric hematology and oncology patients. Pediatr Blood Cancer. 2020;67:1–3.
Mantovani A, Rinaldi E, Zusi C, et al. Coronavirus disease 2019 (COVID-19) in children and/or adolescents: a meta-analysis. Pediatr Res. 2021;89:733–737.
Kuehn BM. More severe obesity leads to more severe COVID-19 in study. JAMA. 2021;325:1–10.
La Fauci G, Montalti M, Di Valerio Z, et al. Obesity and COVID-19 in children and adolescents: reciprocal detrimental influence—systematic literature review and meta-analysis. IJERPH. 2022;19:1–15.
Goubet AG, Dubuisson A, Geraud A, et al. Prolonged SARS-CoV-2 RNA virus shedding and lymphopenia are hallmarks of COVID-19 in cancer patients with poor prognosis. Oncology. 2021;28:3297–3315
Lee J, Park SS, Kim TY, et al. Lymphopenia as a biological predictor of outcomes in COVID-19 patients: a nationwide cohort study. Cancers. 2021;13:1–15.
Węcławek-Tompol J, Zakrzewska Z, Gryniewicz-Kwiatkowska O, et al. COVID-19 in pediatric cancer patients is associated with treatment interruptions but not with short-term mortality: a Polish national study. J Hematol OncolJ Hematol Oncol. 2021;14:1–10.
Moreira DC, Millen GC, Sands S, et al. The care of children with cancer during the COVID-19 Pandemic. Am Soc Clin Oncol Educ Book. 2021;41:e305–e314.
Millen GC, Arnold R, Cazier JB, et al. Severity of COVID-19 in children with cancer: Report from the United Kingdom Paediatric Coronavirus Cancer Monitoring Project. Br J Cancer. 2021;124:754–759.